PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

Size: px
Start display at page:

Download "PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES"

Transcription

1 PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES OCULAR ONCOLOGY PERIOCULAR CUTANEOUS MALIGNANCY

2 Site Group: Ocular Periocular Cutaneous Malignancies Prepared by: Harmeet S. Gill MD, FRCSC and E. Rand Simpson MD, FRCSC Latest Revision: N. Laperriere, H. Krema 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND EARLY DETECTION 3 4. DIAGNOSIS 3 5. PATHOLOGY 4 6. MANAGEMENT MANAGEMENT ALGORITHMS SURGERY CHEMOTHERAPY RADIATION THERAPY OTHER THERAPY ONCOLOGY NURSING PRACTICE CLINIC COORDINATION/MANAGEMENT 8 7. SUPPORTIVE CARE PATIENT EDUCATION PSYCHOSOCIAL CARE SYMPTOM MANAGEMENT CLINICAL NUTRITION PALLIATIVE CARE 9 8. FOLLOW-UP CARE 9 Last Revision Date August

3 1. INTRODUCTION Periocular cutaneous malignancies include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), sebaceous cell carcinoma (SebCC), and cutaneous malignant melanoma (CMM). Five to 10% of all skin carcinomas occur on the eyelid. BCC is the most common skin cancer to affect the face and frequently involves the periocular region. It accounts for about 90% of malignant eyelid tumors. Although it carries a low metastatic potential, the carcinoma is locally invasive and destructive. Left inadequately treated, BCC can cause extensive tissue damage. This has serious functional and aesthetic implications, particularly when involving the eyelid and face. 2. PREVENTION Smoking cessation and decreasing exposure to UV light (sunscreen, sunglasses, hats) are the most effective strategies to prevent periocular cutaneous malignancy and this is particularly important for fair-skinned persons. Immunocompromised patients must have their immune status optimized. 3. SCREENING AND EARLY DETECTION Patients with a personal or family history of cutaneous malignancy or pre-cancerous skin changes (i.e. actinic keratosis) are encouraged to undergo routine screening for early detection. Those who develop suspicious lesions should be evaluated as soon as possible. Patients with syndromic predisposition to cutaneous malignancy (i.e. xeroderma pigmentosum or basal cell nevus syndrome) are typically evaluated for new lesions every 2 to 6 months. 4. DIAGNOSIS Patients are referred to the Princess Margaret Hospital (PMH) ocular oncology service for localized periocular cutaneous malignancies. Those cases with orbital infiltration, regional or systemic metastasis, or cases co-managed with the PMH Head & Neck Oncology service are also evaluated. Clinical features. Non-melanocytic lesions (BCC, SCC) may demonstrate malignant features including loss of eyelashes, distortion of the eyelid margin architecture, ulceration, pearly borders, telangiectatic vessels, induration, lack of tenderness, bleeding, or evidence of rapid growth. Melanocytic tumors (nevus, melanoma) may increase in size (vertical or radial growth), change in shape, increase in pigmentation, or demonstrate some of the features described above for non-melanocytic lesions. Adnexal lesions (SebCC) may masquerade as chronic, unilateral blepharitis or recurrent chalazion or demonstrate the features described above for nonmelanocytic lesions. Any periocular cutaneous maligancy with orbital infiltration may cause vision loss, exophthalmos with or without double vision, decreased eye motility, or lack of trigeminal sensation. During the initial assessment, a complete ophthalmological examination is performed including Snellen visual acuity, pupil reactivity, colour vision, slit-lamp evaluation, dilated funduscopy, assessment of extraocular motility, periocular and facial skin Last Revision Date August

4 assessment, retropulsion, exophthalmometry, dermatomal trigeminal sensation (V1 and V2), and head and neck lymph node palpation. Ancillary testing. Any evidence of orbital involvement requires orbital neuroimaging (CT and MRI with and without contrast). A metastatic work-up is performed for biopsy-proven SebCC and sentinel lymph node biopsy may be considered for CMM. 5. PATHOLOGY An incisional or excisional biopsy can be performed for non-melanocytic tumors. The specimen is sent in formalin for permanent histopathology. The common histomorphologic features of BCC seen with hematoxylin and eosin (H&E) staining include peripheral palisading, myxoid stroma, and artefactual clefting. Those for SCC include large, polygonal eosinophilic keratinocytes that may transform into nests or keratinous pearls with a surrounding inflammatory infiltrate. Poorly differentiated SCC contains more pleomorphic cells and no keratinization. Pigmented or non-pigmented lesions suspicious for a melanocytic lesion (nevus or melanoma) are best treated by excisional biopsy with 1 to 2mm margins and a notouch technique to avoid spillage of tumor cells. The histologic subtypes of CMM include superficial spreading melanomas, nodular melanomas, lentigo maligna melanomas, acral lentigenous melanomas, and mucosal lentiginous melanomas. More than 70% of CMMs are superficial spreading melanomas with haphazardly distributed atypical melanocytes at all levels of the epidermis. Immunohistochemical markers such as HMB-45 or S-100 are commonly used to confirm the diagnosis. Lesions suspicious for SebCC must be sent fresh so that fat stains such as oil-red-o can be used. Because these tumors can undergo pagetoid spread and commonly have multicentric involvement, map biopsies should be performed. SebCCs may grow in nests with central necrosis and foamy cytoplasm. Sometimes the lesion can mimic BCC, SCC, or a Merkel cell tumor. The TNM classification system for cutaneous malignancy (AJCC, 7 th edition) distinguishes non-eyelid and eyelid tumors. TNM classification for eyelid carcinoma PRIMARY TUMOR (T) FOR EYELID CARCINOMA TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ T1: tumor less than or equal to 5mm in greatest dimension (not invading the tarsal plate or eyelid margin) T2a: tumor 5-10mm in greatest dimension or any tumor that invades the tarsal plate or eyelid margin Last Revision Date August

5 T2b: tumor 10-20mm in greatest dimension or involves full-thickness eyelid T3a: tumor greater than 20mm in greatest dimension or any tumor that invades adjacent ocular or orbital structures; any T with perineural tumor invasion T3b: complete tumor resection requires enucleation, exenteration, or bone resection T4: tumor is not resectable because of extensive invasion of ocular, orbital, craniofacial structures, or brain REGIONAL LYMPH NODES (N) FOR EYELID CARCINOMA NX: regional lymph nodes cannot be assessed cn0: no regional lymph node metastasis based upon clinical evaluation or imaging pn0: no regional lymph node metastasis based upon lymph node biopsy N1: regional lymph node metastasis DISTANT METASTASIS (M) FOR EYELID CARCINOMA M0: no distant metastasis M1: distant metastasis ANATOMIC STAGE/PROGNOSTIC GROUPS FOR EYELID CARCINOMA Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IB T2a N0 M0 Stage IC T2b N0 M0 Stage II T3a N0 M0 Stage IIIA T3b N0 M0 Stage IIIB Any T N1 M0 Stage IIIC T4 Any N M0 Stage IV Any T Any N M1 Clark staging for cutaneous malignant melanoma Level I: all tumor cells above basement membrane (in situ) Level II: tumor extends into papillary dermis Level III: tumor extends to interface between papillary and reticular dermis Level IV: tumor extends into reticular dermis Level V: tumor invasion of subcutaneous tissue Breslow classification (thickness) for cutaneous malignant melanoma I: less than or equal to 0.75mm II: mm III: mm IV: greater than or equal to 4mm TNM classification for cutaneous malignant melanoma THICKNESS (T) CLASSIFICATION TX: primary tumor cannot be assessed (shave biopsy, regressed primary) Last Revision Date August

6 Tis: melanoma in situ T1: less than or equal to 1.0mm (a: without ulceration and mitosis less than 1/mm2, b: with ulceration and mitosis greater than or equal to 1/mm2) T2: mm (a: without ulceration, b: with ulceration) T3: mm (a: without ulceration, b: with ulceration) T4: greater than 4.0mm (a: without ulceration, b: with ulceration) REGIONAL LYMPH NODE (N) METASTASIS N0: no evidence of regional lymph node metastasis N1: one lymph node (a: micrometastasis clinically occult) (b: macrometastasis clinically apparent) N2: 2 to 3 lymph nodes (a: micrometastasis, b: macrometastasis, c: in transit metastases/satellite(s), without metastatic lymph nodes (N2a: 2-3 nodes positive for micrometastasis; N2b: 2-3 nodes positive for macrometastasis; N2c: in transit met(s)/satellites(s) without metastatic nodes) N3: 4 or more metastatic nodes or matted nodes or in-transit metastases/ satellite(s) with metastatic node(s) DISTANT METASTASIS (M) M0: no evidence of distant metastasis M1a: distant skin, subcutaneous, or nodal metastases, normal serum lactate dehydrogenase (LDH) level M1b: lung metastases, normal LDH level M1c: all other visceral metastases or any distant metastases with an elevated LDH level MELANOMA STAGING Stage 0 Tis N0 M0 Stage IA T1a N0 M0 Stage IB T1b or T2a N0 M0 Stage IIA T2b or T3a N0 M0 Stage IIB T3b or T4a N0 M0 Stage IIC T4b N0 M0 Stage IIIA T1-T4a N1-2a M0 Stage IIIB T1-T4b T1-T4a T1-T4a/b N1-2a N1-2b N2c Stage IIIC T1-T4b N1-2b M0 T1-T4a/b N3 Stage IV Any T Any N M1a-c M0 6. MANAGEMENT 6.1 Management algorithms Last Revision Date August

7 There are many management options for periocular cutaneous malignancies, both surgical and non-surgical. Some non-surgical options include cryotherapy, radiation, photodynamic therapy, electrodissection and curettage, topical 5-fluorouracil, and topical immune modulators such as imiquimod. A problem with non-surgical management, however, is that no pathological specimen is reviewed to ensure complete tumor eradication. 6.2 Surgery The primary management of BCC maybe surgical excision or radiotherapy. Surgical options may include primary excision with predetermined margins, frozen section (FS)-controlled excision, or Mohs micrographic surgery (MMS). The cure rates using these techniques for periocular BCC fall between 85 to 100%. Surgical resection of biopsy-proven SCC or melanoma is commonly performed in collaboration with Mohs surgeons at networked hospitals. The reconstruction is subsequently performed by an oculoplastic surgeon. Tumors with orbital infiltration who are not candidates for radiation treatment may require orbital exenteration. 6.3 Chemotherapy There are many clinical trials underway for novel chemotherapeutic regimens to treat metastatic melanoma with limited efficacy. 6.4 Radiation therapy Eyelid or orbital radiotherapy may be primary treatment for patients where surgical resections will likely be associated with significant tissue deficits, and quite often in elderly patients where comorbid conditions may increase surgical risks, or at patient discretion after consultation with both surgical and radiation teams. Radiation is also used as adjunctive therapy after tumor resection if clear margins are not achieved for an infiltrative, high-risk malignancy (i.e. morpheaform basal cell carcinoma). Eyelid Tumours Immobilization: Simulation: Technique: Energy: Shielding: Dose: neck rest clinical mark up direct apposition with daily topical anesthetic 75, 100, or 225 kv lead cut out for field definition shielding of globe by gold covered lead shields 3500 cgy/5, 4500 cgy/10, 5000 cgy/20, 6000 cgy/30 Orbital Tumours Immobilization: neck rest and thermoplastic shell, relocatable GTC frame Simulation: CT, possibly MRI on occasion Technique: IMRT with daily Image Guidance with cone beam CT Energy: 6 MV Dose: 6000 cgy/30 for primary tumours Last Revision Date August

8 2000 cgy/5, 3000 cgy/10 for metastatic tumours 6.5 Other therapy In January 2012, the US Food and Drug Administration approved the first moleculartargeted therapy for metastatic or locally advanced BCC known as vismodegib (Erivedge). This therapy remains investigational. 6.6 Oncology nursing practice Patients seen at the Ocular Oncology clinic are invariably outpatients. The initial history and assessment of visual acuity and pupil reactivity is performed by the clinic RN. The RN is often used as an initial point of contact by patients when new symptoms develop or other questions arise. 6.7 Clinic Coordination/Management The identification of a specific disease complex and the direction to appropriate subspecialty care is usually accomplished by a trained ocular oncology clinic coordinator/manager (Lee Penney). This individual is frequently an experienced ophthalmic assistant. Knowledge of the vision care referral base and collection of investigational materials for new patients is of paramount importance as first steps to providing optimal patient care. The coordinator also serves an invaluable function in supporting both patient and family during investigation, therapy, and convalescence. 7 SUPPORTIVE CARE 7.1 Patient education Patients and family members are educated on a one-on-one basis by a consultant during the initial assessment and at every follow-up visit. 7.2 Psychosocial care When patients express or display emotional, psychological, or social concerns an effort is made to address these during the clinical encounter. In rare instances when this is insufficient to deal with all issues, the patient may be referred to the Department of Psychosocial Oncology. 7.3 Symptom management Patients with pain, blurry vision, eye redness or discomfort, are treated with topical artificial tears or other medications as needed. 7.4 Clinical nutrition The role of nutritional advice and support in the ocular oncology patient population is very limited. Patients with dry eye syndrome may be educated about the value of omega-3-fatty acid and flax seed intake while those with age-related macular degeneration may be encouraged to eat green leafy vegetables. Last Revision Date August

9 7.5 Palliative care The medical oncology group facilitates end-of-life palliative care as needed. This occurs very rarely for patients with periocular cutaneous malignancy seen by the ocular oncology service. 7.6 Other Many patients travel from across Canada to the Ocular Oncology service of PMH. The clinic makes every effort to accommodate patients based on travel dates and facilitate lodging when required. 8 FOLLOW-UP CARE Most patients are followed for tumor recurrence and functional and aesthetic rehabilitation post-surgery outside of the ocular oncology service at PMH (i.e. private office). Last Revision Date August

Skin Cancer. 5 Warning Signs. American Osteopathic College of Occupational and Preventive Medicine OMED 2012, San Diego, Monday, October 8, 2012 C-1

Skin Cancer. 5 Warning Signs. American Osteopathic College of Occupational and Preventive Medicine OMED 2012, San Diego, Monday, October 8, 2012 C-1 Skin Cancer AMERICAN OSTEOPATHIC COLLEGE OF OCCUPATIONAL & PREVENTIVE MEDICINE OMED 2012 October 8, 2012 E. Robert Wanat II, D.O., M.P.H. Learning Objectives: Identify the 3 Basic Types of Skin Cancer

More information

Primary Cutaneous Melanoma Pathology Reporting Proforma DD MM YYYY. *Tumour site. *Specimen laterality. *Specimen type

Primary Cutaneous Melanoma Pathology Reporting Proforma DD MM YYYY. *Tumour site. *Specimen laterality. *Specimen type Primary Cutaneous Melanoma Pathology Reporting Proforma Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth DD MM YYYY Sex Male Female

More information

Technicians & Nurses Program

Technicians & Nurses Program ASCRS ASOA Symposium & Congress Technicians & Nurses Program May 6-10, 2016 New Orleans Evaluation and Treatment of Eyelid Malignancies Richard C. Allen MD PhD FACS Professor Section of Ophthalmology Dept.

More information

NAACCR Webinar Series 1

NAACCR Webinar Series 1 Collecting Cancer Data: Melanoma 2013 2014 NAACCR Webinar Series April 3, 2014 Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching

More information

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior

More information

Periocular Malignancies

Periocular Malignancies Periocular Malignancies Andrew Gurwood, O.D., F.A.A.O., Dipl. Marc Myers, O.D., F.A.A.O. Drs. Myers and Gurwood have no financial interests to disclose. Course Description Discussion of the most common

More information

Protocol applies to melanoma of cutaneous surfaces only.

Protocol applies to melanoma of cutaneous surfaces only. Melanoma of the Skin Protocol applies to melanoma of cutaneous surfaces only. Procedures Biopsy (No Accompanying Checklist) Excision Re-excision Protocol revision date: January 2005 Based on AJCC/UICC

More information

47. Melanoma of the Skin

47. Melanoma of the Skin 1 Terms of Use The cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting

More information

SKIN CANCER. Most common cancer diagnosis 40% of all cancers

SKIN CANCER. Most common cancer diagnosis 40% of all cancers SKIN CANCER Most common cancer diagnosis 40% of all cancers OBJECTIVES Review common and uncommon cancers of the skin. Special emphasis on melanoma and dysplastic nevus Review pathology/tnm/staging, which

More information

Clinical characteristics

Clinical characteristics Skin Cancer Fernando Vega, MD Seattle Healing Arts Clinical characteristics Precancerous lesions Common skin cancers ACTINIC KERATOSIS Precancerous skin lesions Actinic keratoses Dysplastic melanocytic

More information

Springer Healthcare. Staging and Diagnosing Cutaneous Melanoma. Concise Reference. Dirk Schadendorf, Corinna Kochs, Elisabeth Livingstone

Springer Healthcare. Staging and Diagnosing Cutaneous Melanoma. Concise Reference. Dirk Schadendorf, Corinna Kochs, Elisabeth Livingstone Concise Reference Staging and Diagnosing Cutaneous Melanoma Dirk Schadendorf, Corinna Kochs, Elisabeth Livingstone Extracted from Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment Published

More information

Identifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018

Identifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 Identifying Skin Cancer Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 American Cancer Society web site Skin Cancer Melanoma Non-Melanoma

More information

Cutaneous Malignancies: A Primer COPYRIGHT. Marissa Heller, M.D.

Cutaneous Malignancies: A Primer COPYRIGHT. Marissa Heller, M.D. Cutaneous Malignancies: A Primer Marissa Heller, M.D. Associate Director of Dermatologic Surgery Department of Dermatology Beth Israel Deaconess Medical Center December 10, 2016 Skin Cancer Non-melanoma

More information

Melanoma. Kaushik Mukherjee MD A. Scott Pearson MD

Melanoma. Kaushik Mukherjee MD A. Scott Pearson MD Melanoma Kaushik Mukherjee MD A. Scott Pearson MD Disclosures You still have to study Not all inclusive No Western blots Extensive use of Google Image Search and Sabiston Melanoma Basics 8 th most common

More information

Skin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012

Skin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012 Skin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012 Case Presentation 57 yo man with 3 month hx of a nonhealing < 1 cm right

More information

Living Beyond Cancer Skin Cancer Detection and Prevention

Living Beyond Cancer Skin Cancer Detection and Prevention Living Beyond Cancer Skin Cancer Detection and Prevention Cutaneous Skin Cancers Identification Diagnosis Treatment options Prevention What is the most common cancer in people? What is the most common

More information

Malignant Melanoma Early Stage. A guide for patients

Malignant Melanoma Early Stage. A guide for patients This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University

More information

Malignant tumors of melanocytes : Part 3. Deba P Sarma, MD., Omaha

Malignant tumors of melanocytes : Part 3. Deba P Sarma, MD., Omaha Malignant tumors of melanocytes : Part 3 Deba P Sarma, MD., Omaha Let s go over one case of melanoma using the following worksheet. Of the various essential information that needs to be included in the

More information

Cutaneous Melanoma: Epidemiology (USA) The Sentinel Node in Head and Neck Melanoma. Cutaneous Melanoma: Epidemiology (USA)

Cutaneous Melanoma: Epidemiology (USA) The Sentinel Node in Head and Neck Melanoma. Cutaneous Melanoma: Epidemiology (USA) The Sentinel Node in Head and Neck Melanoma Cutaneous Melanoma: Epidemiology (USA) 6 th leading cause of cancer among men and women 68,720 new cases of invasive melanoma in 2009 8,650 deaths from melanoma

More information

AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY-

AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY- TX: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ. T1: tumor is 2 cm or smaller AJCC Staging of Head & Neck Cancer (7 th edition, 2010) -LIP & ORAL CAVITY- T2:

More information

Periocular skin cancer

Periocular skin cancer Periocular skin cancer Information for patients Skin cancer involving the skin of the eyelid or around the eye is called a periocular skin cancer. Eyelid skin cancers occur most often on the lower eyelid,

More information

Chapter 2 Staging of Breast Cancer

Chapter 2 Staging of Breast Cancer Chapter 2 Staging of Breast Cancer Zeynep Ozsaran and Senem Demirci Alanyalı 2.1 Introduction Five decades ago, Denoix et al. proposed classification system (tumor node metastasis [TNM]) based on the dissemination

More information

Pathology of the skin. 2nd Department of Pathology, Semmelweis University

Pathology of the skin. 2nd Department of Pathology, Semmelweis University Pathology of the skin 2nd Department of Pathology, Semmelweis University Histology of the skin Epidermis: Stratum corneum Stratum granulosum Stratum spinosum Stratum basale Dermis: papillary and reticular

More information

Basal cell carcinoma 5/28/2011

Basal cell carcinoma 5/28/2011 Goal of this Presentation A practical approach to the diagnosis of cutaneous carcinomas and their mimics Thaddeus Mully, MD University of California San Francisco To review common non-melanoma skin cancers

More information

Vision Health: Conditions, Disorders & Treatments EYELID DISORDERS

Vision Health: Conditions, Disorders & Treatments EYELID DISORDERS Vision Health: Conditions, Disorders & Treatments EYELID DISORDERS There are a number of disorders that can affect the eyelid. Entropion Entropion is an inward turning of the eyelid and lashes toward the

More information

STAGE CATEGORY DEFINITIONS

STAGE CATEGORY DEFINITIONS CLINICAL Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery TX Tis Tis (DCIS) Tis (LCIS) Tis (Paget s) T1 T1mi T1a T1b T1c a b c

More information

Clinical Pathological Conference. Malignant Melanoma of the Vulva

Clinical Pathological Conference. Malignant Melanoma of the Vulva Clinical Pathological Conference Malignant Melanoma of the Vulva History F/48 Chinese Married Para 1 Presented in September 2004 Vulval mass for 2 months Associated with watery and blood stained discharge

More information

Glenn D. Goldman, MD. University of Vermont Medical Center. University of Vermont College of Medicine

Glenn D. Goldman, MD. University of Vermont Medical Center. University of Vermont College of Medicine Glenn D. Goldman, MD University of Vermont Medical Center University of Vermont College of Medicine Recognize and identify the main types of skin cancer and their precursors Identify and understand new

More information

Dermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses.

Dermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses. Squamous cell carcinoma (SCC): A common malignant tumor of keratinocytes arising in the epidermis, usually from a precancerous condition: 1- UV induced actinic keratosis, usually of low grade malignancy.

More information

Exenteration. Introduction. The skin. Epidermal malignancies 8/3/2017. Neglected basal cell carcinoma

Exenteration. Introduction. The skin. Epidermal malignancies 8/3/2017. Neglected basal cell carcinoma Jeremiah Tao, MD, FACS Director, Oculoplastic and Orbital Surgery Associate Professor, UC Irvine Neglected basal cell carcinoma Exenteration Introduction Chief question with any eyelid lesion: Suspicious

More information

Interesting Case Series. Aggressive Tumor of the Midface

Interesting Case Series. Aggressive Tumor of the Midface Interesting Case Series Aggressive Tumor of the Midface Adrian Frunza, MD, Dragos Slavescu, MD, and Ioan Lascar, MD, PhD Bucharest Emergency Clinical Hospital, Bucharest University School of Medicine,

More information

WHAT DOES THE PATHOLOGY REPORT MEAN?

WHAT DOES THE PATHOLOGY REPORT MEAN? Melanoma WHAT IS MELANOMA? Melanoma is a type of cancer that affects cells called melanocytes. These cells are found mainly in skin but also in the lining of other areas such as nose and rectum, and also

More information

1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter.

1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter. Skin Cancer follow up guidelines If NEW serious diagnosis given: 1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter. 2. Free prescription information details. 3.

More information

AJCC 8 Implementation January 1, 2018 Melanoma of the Skin. Suraj Venna

AJCC 8 Implementation January 1, 2018 Melanoma of the Skin. Suraj Venna AJCC 8 Implementation January 1, 2018 Melanoma of the Skin Suraj Venna Personalized Medicine AJCC 8 th Edition This Time It s Personal Traditional AJCC (TNM) population-based analyses of large databases

More information

Melanoma-Back to Basics I Thought I Knew Ya! Paul K. Shitabata, M.D. Dermatopathologist APMG

Melanoma-Back to Basics I Thought I Knew Ya! Paul K. Shitabata, M.D. Dermatopathologist APMG Melanoma-Back to Basics I Thought I Knew Ya! Paul K. Shitabata, M.D. Dermatopathologist APMG At tumor board, a surgeon insists that all level II melanomas are invasive since they have broken through the

More information

Gastric Cancer Histopathology Reporting Proforma

Gastric Cancer Histopathology Reporting Proforma Gastric Cancer Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given name(s) Date of birth Sex Male Female Intersex/indeterminate

More information

Malignant Melanoma Introduction increasing incidence increasing mortality skin >50% normal skin pigmented lesion

Malignant Melanoma Introduction increasing incidence increasing mortality skin >50% normal skin pigmented lesion 1 Malignant Melanoma Introduction Melanoma is a malignant tumor of melanocytes, cells that are derived from the neural crest. There is an increasing incidence of melanoma, as well as an increasing mortality,

More information

Benign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc

Benign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc 1 Benign versus Cancerous Lesions How to tell the difference FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc Benign lesions Seborrheic Keratoses: Warty, stuck-on Genetics and birthdays Can start in late

More information

Melanoma Quality Reporting

Melanoma Quality Reporting Melanoma Quality Reporting September 1, 2013 December 31, 2016 Laurence McCahill, MD Surgical Oncologist Metro Health Surgical Oncology Metro Health Professional Building 2122 Health Drive SW Wyoming,

More information

Melanoma Case Scenario 1

Melanoma Case Scenario 1 Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5

More information

Desmoplastic Melanoma R/O BCC. Clinical Information. 74 y.o. man with lesion on left side of neck r/o BCC

Desmoplastic Melanoma R/O BCC. Clinical Information. 74 y.o. man with lesion on left side of neck r/o BCC R/O BCC Sabine Kohler, M.D. Professor of Pathology and Dermatology Dermatopathology Service Stanford University School of Medicine Clinical Information 74 y.o. man with lesion on left side of neck r/o

More information

Melanoma Case Scenario 1

Melanoma Case Scenario 1 Melanoma Case Scenario 1 History and physical 11/5/16 Patient is a single, 48-year-old male in good health who presented to his primary physician for a yearly physical exam during which a 3.4 x 2.8 x 1.5

More information

Collaborative Stage for TNM 7 - Revised 12/02/2009 [ Schema ]

Collaborative Stage for TNM 7 - Revised 12/02/2009 [ Schema ] CS Tumor Size Collaborative Stage for TNM 7 - Revised 12/02/2009 [ Schema ] Note: the specific tumor size as documented in the medical record. If the ONLY information regarding tumor size is the physician's

More information

Only the Mohs Knows: Management of Periocular Skin Cancers

Only the Mohs Knows: Management of Periocular Skin Cancers Only the Mohs Knows: Management of Periocular Skin Cancers Andrew R. Harrison, M.D. Director, Oculoplastic and Orbital Surgery University of Minnesota Overview Common Eyelid Skin Cancers Management Options

More information

Subject Index. Dry desquamation, see Skin reactions, radiotherapy

Subject Index. Dry desquamation, see Skin reactions, radiotherapy Subject Index Actinic keratosis disseminated disease 42 surgical excision 42 AIDS, see Kaposi s sarcoma Amifostine, skin reaction prophylaxis 111 Basal cell carcinoma, superficial X-ray therapy Bowen s

More information

Collaborative Stage for TNM 7 - Revised 07/14/2009 [ Schema ]

Collaborative Stage for TNM 7 - Revised 07/14/2009 [ Schema ] MelanomaSkin CS Tumor Size Collaborative Stage for TNM 7 - Revised 07/14/2009 [ Schema ] Code 000 No mass/tumor found Description 001-988 001-988 millimeters (code exact size in millimeters) 989 989 millimeters

More information

Glenn D. Goldman, MD. Fletcher Allen Health Care. University of Vermont College of Medicine

Glenn D. Goldman, MD. Fletcher Allen Health Care. University of Vermont College of Medicine Glenn D. Goldman, MD Fletcher Allen Health Care University of Vermont College of Medicine Recognize and identify the main types of skin cancer Understand how and why Mohs surgery is utilized for the treatment

More information

Histopathology: skin pathology

Histopathology: skin pathology Histopathology: skin pathology These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual information

More information

Large majority caused by sun exposure Often sun exposure before age 20 Persons who burn easily and tan poorly are at greatest risk.

Large majority caused by sun exposure Often sun exposure before age 20 Persons who burn easily and tan poorly are at greatest risk. Basics of Skin Cancer Detection and Treatment of Non- Melanoma Skin Cancers Large majority caused by sun exposure Often sun exposure before age 20 Persons who burn easily and tan poorly are at greatest

More information

David B. Troxel, MD. Common Medicolegal Situations: Misdiagnosis of Melanoma

David B. Troxel, MD. Common Medicolegal Situations: Misdiagnosis of Melanoma Common Medicolegal Situations: Misdiagnosis of Melanoma David B. Troxel, MD Medical Director, The Doctors Company, Napa, California Clinical Professor Emeritus, University of California at Berkeley Past

More information

NAACCR Hospital Registry Webinar Series

NAACCR Hospital Registry Webinar Series NAACCR Hospital Registry Webinar Series October 4, 2007 Abstracting Melanoma Cancer Incidence and Treatment Data Image source: commons.wikimedia.org/wiki/image.melanoma.jpg Sites include Melanoma Skin

More information

North of Scotland Cancer Network Clinical Management Guideline for Malignant Melanoma

North of Scotland Cancer Network Clinical Management Guideline for Malignant Melanoma Nth of Scotland Cancer Netwk Clinical Management Guideline f Malignant Melanoma Based on WOSCAN CMG with further consultation within NOSCAN UNCONTROLLED WHEN PRINTED Prepared by Approved by Issue date

More information

Update on 8 th Edition Cutaneous AJCC Staging of Primary Cutaneous Melanoma. Michael T. Tetzlaff MD, PhD

Update on 8 th Edition Cutaneous AJCC Staging of Primary Cutaneous Melanoma. Michael T. Tetzlaff MD, PhD Update on 8 th Edition Cutaneous AJCC Staging of Primary Cutaneous Melanoma Michael T. Tetzlaff MD, PhD Associate Professor Departments of Pathology (Dermatopathology) and Translational and Molecular Pathology

More information

Skin Cancer 101: Diagnosis and Management of the Most Common Cancer

Skin Cancer 101: Diagnosis and Management of the Most Common Cancer Skin Cancer 101: Diagnosis and Management of the Most Common Cancer Sarah Patton, PA-C, MSHS Skin Surgery Center www.skinsurgerycenter.com Seattle/Bellevue, WA Skin cancer Skin cancer is by far the most

More information

Know who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated

Know who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated Lindy P. Fox, MD Associate Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant

More information

Know who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated

Know who is at risk: LOOK! for ABCDs, rapidly changing lesions, do a biopsy when indicated Lindy P. Fox, MD Assistant Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco Applies to adults without history of malignancy or premalignant

More information

Nasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa

Nasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa Nasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa No financial disclosures No discussion of off-label use of medications or unapproved devices 67 year old male referred to Oculoplastics

More information

46. Merkel Cell Carcinoma

46. Merkel Cell Carcinoma 1 Terms of Use The cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting

More information

Updates on Melanoma: Are You Following the Latest Guidelines of Care? Jerry Brewer, MD

Updates on Melanoma: Are You Following the Latest Guidelines of Care? Jerry Brewer, MD Updates on Melanoma: Are You Following the Latest Guidelines of Care? Jerry Brewer, MD Disclosure Statement Update on Melanoma Are You Following the Latest Guidelines of Care? I, Jerry D. Brewer, MD, do

More information

Learning Objectives. Tanning. The Skin. Classic Features. Sun Reactive Skin Type Classification. Skin Cancers: Preventing, Screening and Treating

Learning Objectives. Tanning. The Skin. Classic Features. Sun Reactive Skin Type Classification. Skin Cancers: Preventing, Screening and Treating Learning Objectives Skin Cancers: Preventing, Screening and Treating Robert A. Baldor, MD, FAAFP Professor, Family Medicine & Community Health University of Massachusetts Medical School Distinguish the

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR Last Revision Date July 2015 1 Site Group: Gynecologic Cancer Vulvar Author: Dr. Stephane Laframboise 1. INTRODUCTION

More information

Contrast with Australian Guidelines A/Pr Pascale Guitera,

Contrast with Australian Guidelines A/Pr Pascale Guitera, Contrast with Australian Guidelines A/Pr Pascale Guitera, Dermatologist, Sydney University NO CONFLICT OF INTEREST Sydney Melanoma Diagnostic Centre, RPAH 2011 2008 225 pages 16 pages http://www.cancer.org.au/file/healthprofessionals/clinica

More information

I have a skin lump doc! What s next? 12 th August 2017 Dr. Sue-Ann Ho Ju Ee

I have a skin lump doc! What s next? 12 th August 2017 Dr. Sue-Ann Ho Ju Ee I have a skin lump doc! What s next? 12 th August 2017 Dr. Sue-Ann Ho Ju Ee Some thoughts Is this skin cancer? How common is this? How likely is this in this patient? What happens next if it s something

More information

Melanoma 10/6/16. Please submit all questions concerning webinar content through the Q&A panel. Reminder:

Melanoma 10/6/16. Please submit all questions concerning webinar content through the Q&A panel. Reminder: Collecting NAACCR Cancer Data: 2015-2016 Melanoma Webinar Series NAACCR 2016-2017 Webinar Series Presented by: Angela Martin amartin@naaccr.org Jim Hofferkamp jhofferkamp@naaccr.org Q&A Please submit all

More information

This form may provide more data elements than required for collection by standard setters such as NCI SEER, CDC NPCR, and CoC NCDB.

This form may provide more data elements than required for collection by standard setters such as NCI SEER, CDC NPCR, and CoC NCDB. 1 Terms of Use The cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination, and staging evaluation, or for documenting

More information

IT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY

IT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY IT S FUNDAMENTAL MY DEAR WATSON! A SHERLOCKIAN APPROACH TO DERMATOLOGY Skin, Bones, and other Private Parts Symposium Dermatology Lectures by Debra Shelby, PhD, DNP, FNP-BC, FADNP, FAANP Debra Shelby,

More information

SKIN HISTOLOGY AND FUNCTION

SKIN HISTOLOGY AND FUNCTION SKIN HISTOLOGY AND FUNCTION THREE LAYERS : EPIDERMIS BASEMENT MEMBRANE DERMIS EPIDERMIS : COMPOSED OF KERATINOCYTES NO MATRIX DEEP BASAL LAYER MITOTICALLY ACTIVE SPINOUS LAYER MATURE HYALIN HORNY LAYER

More information

Modalities of Radiation

Modalities of Radiation Modalities of Radiation Superficial radiotherapy Orthovoltage Megavoltage Photons Electrons Brachytherapy Interstitial Moulds When to refer? The vast majority of skin cancers will be managed without any

More information

Oral cancer: Prognosis & Treatment. Dr. Hani Al Sheikh Radhi

Oral cancer: Prognosis & Treatment. Dr. Hani Al Sheikh Radhi Oral cancer: Prognosis & Treatment Dr. Hani Al Sheikh Radhi Prognostic factors in Oral caner TNM staging T stage N stage M stage Site Histological Factors Vascular & Perineural Invasion Surgical Margins

More information

1. Opdivo + Ipilumimab is now the first line therapy for metastatic melanoma.

1. Opdivo + Ipilumimab is now the first line therapy for metastatic melanoma. Melanoma UpToDate: Introduction: Risk Factors: 1. Opdivo + Ipilumimab is now the first line therapy for metastatic melanoma. Median age = 50 yrs Incidence is rising - Sun exposure: UVB (290-320nm) > UVA

More information

You Are Going to Cut How Much Skin? Locoregional Surgical Treatment. Justin Rivard MD, MSc, FRCSC September 21, 2018

You Are Going to Cut How Much Skin? Locoregional Surgical Treatment. Justin Rivard MD, MSc, FRCSC September 21, 2018 You Are Going to Cut How Much Skin? Locoregional Surgical Treatment Justin Rivard MD, MSc, FRCSC September 21, 2018 Presenter Disclosure Faculty/Speaker: Justin Rivard Relationships with financial sponsors:

More information

Cervical cancer presentation

Cervical cancer presentation Carcinoma of the cervix: Carcinoma of the cervix is the second commonest cancer among women worldwide, with only breast cancer occurring more commonly. Worldwide, cervical cancer accounts for about 500,000

More information

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC)

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) I.Kostadinova, Sofia, Bulgaria CMM some clinical facts The incidence

More information

ACRIN 6666 Therapeutic Surgery Form

ACRIN 6666 Therapeutic Surgery Form S1 ACRIN 6666 Therapeutic Surgery Form 6666 Instructions: Complete a separate S1 form for each separate area of each breast excised with the intent to treat a cancer (e.g. each lumpectomy or mastectomy).

More information

Melanoma Underwriting Presented at 2018 AHOU Conference. Hank George FALU

Melanoma Underwriting Presented at 2018 AHOU Conference. Hank George FALU Melanoma Underwriting Presented at 2018 AHOU Conference Hank George FALU MELANOMA EPIDEMIOLOGY 70-80,000 American cases annually Majority are in situ or thin > 20% are diagnosed age 45 8-9,000 melanoma

More information

أملس عضلي غرن = Leiomyosarcoma. Leiomyosarcoma 1 / 5

أملس عضلي غرن = Leiomyosarcoma. Leiomyosarcoma 1 / 5 Leiomyosarcoma 1 / 5 EPIDEMIOLOGY Exact incidence is unknown, but older studies suggest that leiomyosarcomas comprise approximately 3 percent of soft-tissue sarcomas. Superficial leiomyosarcoma occurs

More information

MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER

MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER MUSCLE-INVASIVE AND METASTATIC BLADDER CANCER (Text update March 2008) A. Stenzl (chairman), N.C. Cowan, M. De Santis, G. Jakse, M. Kuczyk, A.S. Merseburger, M.J. Ribal, A. Sherif, J.A. Witjes Introduction

More information

UICC TNM 8 th Edition Errata

UICC TNM 8 th Edition Errata UICC TNM 8 th Edition Errata ions are in italics Page 28 Oropharynx p16 positive Pathological Stage II,T2 N2 M0 T3 N0,N1 M0 Stage II,T2 N2 M0 T3,T4 N0,N1 M0 Page 61 Oesophagus Adenocarcinoma Pathological

More information

Melanoma Update: 8th Edition of AJCC Staging System

Melanoma Update: 8th Edition of AJCC Staging System Melanoma Update: 8th Edition of AJCC Staging System Rosalie Elenitsas, M.D. Professor of Dermatology Director, Dermatopathology University of Pennsylvania DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY None

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION

More information

Identifying Benign and Malignant Skin Lesions. No Disclosures. Common Benign Lesions. Benign Lesions 2/25/2018. Stucco Keratoses.

Identifying Benign and Malignant Skin Lesions. No Disclosures. Common Benign Lesions. Benign Lesions 2/25/2018. Stucco Keratoses. Dermatology in Primary Care Identifying Benign and Malignant Skin Lesions Christy Quire Baker, APRN, FNP-BC, DCNP Dermatology Certified Nurse Practitioner No Disclosures Common Benign Lesions Seborrheic

More information

Michael T. Tetzlaff MD, PhD

Michael T. Tetzlaff MD, PhD Update on American Joint Cancer Committee (AJCC) staging system for primary cutaneous melanoma Emphasis on concise and accurate reporting of primary and metastatic melanoma for effective risk stratification

More information

Malignant Melanoma in Turkey: A Single Institution s Experience on 475 Cases

Malignant Melanoma in Turkey: A Single Institution s Experience on 475 Cases Malignant Melanoma in Turkey: A Single Institution s Experience on 475 Cases Faruk Tas, Sidika Kurul, Hakan Camlica and Erkan Topuz Institute of Oncology, Istanbul University, Istanbul, Turkey Received

More information

Proposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram

Proposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram Proposed All Wales Vulval Cancer Guidelines Dr Amanda Tristram Previous FIGO staging FIGO Stage Features TNM Ia Lesion confined to vulva with

More information

Melanoma of the Skin INTRODUCTION SUMMARY OF CHANGES

Melanoma of the Skin INTRODUCTION SUMMARY OF CHANGES 24 Melanoma of the Skin C44.0 Skin of lip, NOS C44.1 Eyelid C44.2 External ear C44.3 Skin of other and unspecified parts of face C44.4 Skin of scalp and neck C44.5 Skin of trunk C44.6 Skin of upper limb

More information

Skin Cancer of the Nose: Common and Uncommon

Skin Cancer of the Nose: Common and Uncommon Skin Cancer of the Nose: Common and Uncommon Mark Russell, M.D. Associate Professor of Dermatology, Otolaryngology, and Pathology University of Virginia Objectives Review clinical presentations of select

More information

General information about skin cancer

General information about skin cancer Skin Cancer General information about skin cancer Key points Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. There are different types of cancer that start in

More information

Completing the Puzzle AJCC TNM Staging Breast. Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017

Completing the Puzzle AJCC TNM Staging Breast. Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017 Completing the Puzzle AJCC TNM Staging Breast Nicole Catlett, CTR 2017 Kentucky Cancer Registry Fall Conference, September 21 & 22, 2017 OBJECTIVES Understanding of Breast TNM staging Identify clinical

More information

Seventh Edition Staging 2017 Melanoma. Overview. This webinar is sponsored by. the Centers for Disease Control and Prevention.

Seventh Edition Staging 2017 Melanoma. Overview. This webinar is sponsored by. the Centers for Disease Control and Prevention. Seventh Edition Staging 2017 Melanoma Donna M. Gress, RHIT, CTR Validating science. Improving patient care. No materials in this presentation may be repurposed in print or online without the express written

More information

Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema

Collaborative Staging Manual and Coding Instructions Part II: Primary Site Schema C44.0-C44.9, C51.0-C51.2, C51.8-C51.9, C60.0-C60.2, C60.8-C60.9, C63.2 (M-8720-8790) C44.0 Skin of lip, NOS C44.1 Eyelid C44.2 External ear C44.3 Skin of ear and unspecified parts of face C44.4 Skin of

More information

MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER

MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER 10 MUSCLE - INVASIVE AND METASTATIC BLADDER CANCER Recommendations from the EAU Working Party on Muscle Invasive and Metastatic Bladder Cancer G. Jakse (chairman), F. Algaba, S. Fossa, A. Stenzl, C. Sternberg

More information

Tumours of the Oesophagus & Gastro-Oesophageal Junction Histopathology Reporting Proforma

Tumours of the Oesophagus & Gastro-Oesophageal Junction Histopathology Reporting Proforma Tumours of the Oesophagus & Gastro-Oesophageal Junction Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given

More information

Vulvar Carcinoma. Definition: Cases should be classified as carsinoma of the vulva when the primary site growth is in the vulva Malignant melanoma sho

Vulvar Carcinoma. Definition: Cases should be classified as carsinoma of the vulva when the primary site growth is in the vulva Malignant melanoma sho Carcinoma Vulva & Vagina Subdivisi Onkologi Ginekologi Bagian Obgin FK USU Vulvar Carcinoma. Definition: Cases should be classified as carsinoma of the vulva when the primary site growth is in the vulva

More information

Melanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media

Melanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media Melanoma and Dermoscopy Richard P. Usatine, MD, FAAFP Professor, Family and Community Medicine Professor, Dermatology and Cutaneous Surgery Medical Director, University Skin Clinic University of Texas

More information

Nonmelanoma skin cancers

Nonmelanoma skin cancers Skin cancer Philip Clarke Nonmelanoma skin cancers Treatment options Background Australia has one of the highest skin cancer rates in the world. Early detection and treatment of skin cancer is vital to

More information

PanMidlands Ocular Cancer Pathway March 2008 Approved by The Midland Oculoplastic Surgery Society

PanMidlands Ocular Cancer Pathway March 2008 Approved by The Midland Oculoplastic Surgery Society PanMidlands Ocular Cancer Pathway March 2008 Approved by The Midland Oculoplastic Surgery Society Periocular Skin Pathway Referrals to Oculoplastics Strong Indication: Lesion within orbital rim Medial

More information

Case Scenario 1 History and Physical 3/15/13 Imaging Pathology

Case Scenario 1 History and Physical 3/15/13 Imaging Pathology Case Scenario 1 History and Physical 3/15/13 The patient is an 84 year old white female who presented with an abnormal mammogram. The patient has a five year history of refractory anemia with ringed sideroblasts

More information

Descriptor Definition Author s notes TNM descriptors Required only if applicable; select all that apply multiple foci of invasive carcinoma

Descriptor Definition Author s notes TNM descriptors Required only if applicable; select all that apply multiple foci of invasive carcinoma S5.01 The tumour stage and stage grouping must be recorded to the extent possible, based on the AJCC Cancer Staging Manual (7 th Edition). 11 (See Tables S5.01a and S5.01b below.) Table S5.01a AJCC breast

More information